414990 LA.indd 1 7/28/11 7:14 PM

You may pay online with a credit card, print an invoice to pay with a check, or indicate a Purchase Order number and print an associated invoice for payment. (Please note that your Ambassador is not officially accepted into the program until the registration fee is received.) To pay at a later time, save and logout, then simply log back in with the HOBY School ID and password and follow the instructions to make a payment.

414990 LA.indd 2 7/28/11 7:14 PM

Instructions for School Personnel to Register a Student: 1. DO NOT SEND THIS FORM TO HOBY. 2. Have your selected HOBY Ambassador and Alternate complete the entire Student Information section. 3. Visit www.hoby.org and click on the link to register a student online. 5. Enter the HOBY school ID and password, then enter all the information on this form online. 6. Payment instructions will be provided once the student’s registration has been submitted online. 7. A confirmation message will be emailed once payment has been received by HOBY.

2012 HOBY REGISTRATION WORKSHEET

Student Information (Please PRINT clearly or type)

Male/ Female

Mailing Address:

City: State:

Zip Code: Home Phone: ( )

Cell Phone: ( ) _____________ I would like to opt out of receiving text messages from HOBY. Email

Date of Birth: / / Preferred Name:

For nametag

T-shirt Size: S M L XL XXL XXXL

Ethnicity (for statistical purpose only): African American Asian Caucasian Latino Middle Eastern Pacific Islander Native American Other

I understand I must be able to attend the assigned seminar for the entire weekend, including overnight.

Please keep me off the list to receive outstanding offers from HOBY approved scholarships, affiliates, partners, and companies. Mother or Guardian’s Name: Phone: (H) ( ) (W) ( ) Cell: ( ) Email: Title/Employer: Father or Guardian's Name: Phone: (H) ( ) (W) ( ) Cell: ( ) Email: Title/Employer:

Last Middle First

Please provide to receive pre-seminar materials and confirmation of acceptance

High School Information High School Name: School District:

Address: Website: School County: Contact Person/Title: Principal Name: Contact Email: Principal E-mail: Contact Phone: ( ) Ext. School Phone: ( ) Fax: ( ) Local Newspaper: Newspaper Email/Website:

All registrations must be submitted online at www.hoby.org. Paper registrations will not be accepted. Please do not fax or mail this form to HOBY.

Alternate Student Information

Male/ Female

Mailing Address:

City: State:

Zip Code: Home Phone: ( )

Cell Phone: ( ) _____________ I would like to opt out of receiving text messages from HOBY. Email

Date of Birth: / / Preferred Name:

For nametag

T-shirt Size: S M L XL XXL XXXL

Ethnicity (for statistical purpose only): African American Asian Caucasian Latino Middle Eastern Pacific Islander Native American Other

I understand I must be able to attend the assigned seminar for the entire weekend, including overnight.

Please keep me off the list to receive outstanding offers from HOBY approved scholarships, affiliates, partners, and companies. Mother or Guardian’s Name: Phone: (H) ( ) (W) ( ) Cell: ( ) Email: Title/Employer: Father or Guardian's Name: Phone: (H) ( ) (W) ( ) Cell: ( ) Email:

Title/Employer:

Last Middle First Suffix

Please provide to receive pre-seminar materials and confirmation of acceptance

In the event the originally selected student is unable to attend

Suffix

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414990 LA.indd 1 7/28/11 7:14 PM - HOBY

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